Thrombosis in nephrotic syndrome

Q: 28 year old female with established diagnosis of nephrotic syndrome admitted to ICU with shortness of breath (SOB) and diagnosis of pulmonary embolism (PE). Work up showed hypoalbuminemia and renal vein thrombosis (RVT). What is the risk correlation between hypoalbuminemia and RVT?


Answer:  

The risk for arterial thrombosis, deep vein thrombosis (DVT) and renal vein thrombosis (RVT) gets proportionally high with the severity of the hypoalbuminemia. Once the serum albumin concentration is ≤2.8 g/dL, the risk starts to rise with a 2.13-fold increase for every 1 g/dL decrease in albumin below this level. 

Treatment consist as of any other acute thrombosis depending on the severity including anticoagulation, systemic or catheter based thrombolytic therapy or thrombectomy, followed by maintenance of warfarin therapy with INR goal of 2-3.

#nephrology
#hematology



Reference:

1. Lionaki S, Derebail VK, Hogan SL, et al. Venous thromboembolism in patients with membranous nephropathy. Clin J Am Soc Nephrol 2012; 7:43.

2. Weger N, Stawicki SP, Roll G, et al. Bilateral renal vein thrombosis secondary to membraneous glomerulonephritis: successful treatment with thrombolytic therapy. Ann Vasc Surg 2006; 20:411.


3. Dupree LH, Reddy P. Use of rivaroxaban in a patient with history of nephrotic syndrome and hypercoagulability. Ann Pharmacother 2014; 48:1655.